Renin-angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: a retrospective cohort study
Open accessAbstract
Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak initiated on the Diamond Princess Cruise Ship at Yokohama harbor in February 2020, we have been doing our best to treat COVID-19 patients. In animal experiments, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II type-1 receptor blockers (ARBs) are reported to suppress the downregulation of angiotensin converting enzyme 2 (ACE2), and they may inhibit the worsening of pathological conditions. We aimed to examine whether preceding use of ACEIs and ARBs affected the clinical manifestations and prognosis of COVID-19 patients. One hundred fifty-one consecutive patients (mean age 60 ± 19 years) with polymerase-chain-reaction proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who were admitted to six hospitals in Kanagawa Prefecture, Japan, were analyzed in this multicenter retrospective observational study. Among all COVID-19 patients, in the multiple regression analysis, older age (age ≥ 65 years) was significantly associated with the primary composite outcome (odds ratio (OR) 6.63, 95% confidence interval (CI) 2.28-22.78, P < 0.001), which consisted of (i) in-hospital death, (ii) extracorporeal membrane oxygenation, (iii) mechanical ventilation, including invasive and noninvasive methods, and (iv) admission to the intensive care unit. In COVID-19 patients with hypertension, preceding ACEI/ARB use was significantly associated with a lower occurrence of new-onset or worsening mental confusion (OR 0.06, 95% CI 0.002-0.69, P = 0.02), which was defined by the confusion criterion, which included mild disorientation or hallucination with an estimation of medical history of mental status, after adjustment for age, sex, and diabetes. In conclusion, older age was a significant contributor to a worse prognosis in COVID-19 patients, and ACEIs/ARBs could be beneficial for the prevention of confusion in COVID-19 patients with hypertension.
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AngII-AT1R axis inhibitors may be beneficial for COVID-19 patients to decrease serum IL-6 levels.
“Consistent with animal models, it was reported that AngII–AT1R axis inhibitors may be beneficial for COVID-19 patients (360–363) to decrease serum IL-6 levels (360).”
From IL-6 in inflammation, autoimmunity and cancer (2021) · cites this paper as [362]
In the ‘Frequency (%)’ discussion (page unavailable), the paper reports possible benefits of ACE inhibitors and ARBs and cites a small study of COVID-19 patients with hypertension in which IL-6 tended to be lower among users. It does not show that the inhibitors decreased serum IL-6: the IL-6 observation is a reported group comparison, not a measured change or an established treatment effect. (LLM, conf=0.82)
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References 22 · Cited by 52
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- Authors
- Matsuzawa, Y., Ogawa, H., Kimura, K., Konishi, M., Kirigaya, J., Fukui, K., Tsukahara, K., Shimizu, H., Iwabuchi, K., Yamada, Y., Saka, K., Takeuchi, I., Hirano, T., & Tamura, K.
- Affiliations
- Yokohama City University Medical Center (JP)
- National Cerebral and Cardiovascular Center (JP)
- Yokohama City University (JP)
- Kanagawa Cardiovascular and Respiratory Center (JP)
- Fujisawa City Hospital (JP)
- Yokosuka City Hospital (JP)
- National Institutes for Quantum Science and Technology (JP)
- Corresponding author
- Matsuzawa, Yasushi
- ORCID
- Venue
- Hypertension Research
- Published
- 2020-08-21
- Volume
- 43
- Issue
- 11
- Pages
- 1257-1266
- ISSN
- 0916-9636 (ISSN-L)
- 1348-4214
- OpenAlex
- W3081407919
- Cited by
- 52
- References
- 22
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 10 · 2021: 24 · 2020: 10
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension Research (publishedVersion)
- PubMed (publishedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
- QST-Repository (National Institutes for Quantum and Radiological Science and Technology) (submittedVersion, cc-by-nc-nd)
- Funders
- Japan Agency for Medical Research and Development
- Japan Society for the Promotion of Science
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, renin-angiotensin system inhibitors, ACE inhibitors, angiotensin receptor blockers, SARS-CoV-2, disease severity, prognosis, in-hospital mortality, extracorporeal membrane oxygenation, mechanical ventilation, intensive care unit admission, hypertension, mental status, ACE2 downregulation
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Age Factors, Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors, Confusion, Female, Humans, Hypertension, Male, Middle Aged, Pneumonia, Viral, Retrospective Studies, Severity of Illness Index, Coronavirus Infections, Angiotensin II Type 1 Receptor Blockers, Pandemics
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